scholarly journals Assessing the Relative Effectiveness of Combining Self-Care with Practitioner-Delivered Complementary and Integrative Health Therapies to Improve Pain in a Pragmatic Trial

Pain Medicine ◽  
2020 ◽  
Vol 21 (Supplement_2) ◽  
pp. S100-S109
Author(s):  
Steven B Zeliadt ◽  
Scott Coggeshall ◽  
Hannah Gelman ◽  
Marlena H Shin ◽  
A Rani Elwy ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
Pragmatic Trial ◽  
Self Care ◽  
Pain Patient ◽  
Business Practices ◽  
Health Administration ◽  
Integrative Health ◽  
Patient Reported ◽  
Care Systems

Abstract Background Many health care systems are beginning to encourage patients to use complementary and integrative health (CIH) therapies for pain management. Many clinicians have anecdotally reported that patients combining self-care CIH therapies with practitioner-delivered therapies report larger health improvements than do patients using practitioner-delivered or self-care CIH therapies alone. However, we are unaware of any trials in this area. Design The APPROACH Study (Assessing Pain, Patient-Reported Outcomes and Complementary and Integrative Health) assesses the value of veterans participating in practitioner-delivered CIH therapies alone or self-care CIH therapies alone compared with the combination of self-care and practitioner-delivered care. The study is being conducted in 18 Veterans Health Administration sites that received funding as part of the Comprehensive Addiction and Recovery Act to expand availability of CIH therapies. Practitioner-delivered therapies under study include chiropractic care, acupuncture, and therapeutic massage, and self-care therapies include tai chi/qi gong, yoga, and meditation. The primary outcome will be improvement on the Brief Pain Inventory 6 months after initiation of CIH as compared with baseline scores. Patients will enter treatment groups on the basis of the care they receive because randomizing patients to specific CIH therapies would require withholding therapies routinely offered at VA. We will address selection bias and confounding by using sites’ variations in business practices and other encouragements to receive different types of CIH therapies as a surrogate for direct randomization by using instrumental variable econometrics methods. Summary Real-world evidence about the value of combining self-care and practitioner-delivered CIH therapies from this pragmatic trial will help guide the VA and other health care systems in offering specific nonpharmacological approaches to manage patients’ chronic pain.

scholarly journals Patient-Reported Outcomes Collected as Part of the Medicare Annual Wellness Visit in the Health Care Systems Research Network

2016 ◽  
Vol 3 (3) ◽  
pp. 168 ◽  
Author(s):  
Heather Tabano ◽  
Thomas Gill ◽  
Kathryn Anzuoni ◽  
Heather Allore ◽  
Ann Gruber-Baldini ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Reported Outcomes ◽  
Health Care Systems ◽  
Research Network ◽  
Systems Research ◽  
Patient Reported ◽  
Care Systems

Alternative Healing as Magical Self-Care in Alternative Modernity

Numen ◽  
2015 ◽  
Vol 62 (4) ◽  
pp. 431-459
Author(s):  
Anne Koch
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
Self Care ◽  
Spiritual Healing ◽  
Medical Pluralism ◽  
Medical Treatments ◽  
Alternative Healing ◽  
Alternative Modernities ◽  
Care Systems ◽  
Rational Knowledge

Alternative healing, including spiritual healing, unconventional, traditional/folk, and complementary medical treatments, is an increasingly relevant health-care resource in contemporary health-care systems, and a broad, constantly changing, and heterogeneous field of medical pluralism. Some suggestions for classifying spiritual healing as presented in the academic and gray literature are summarized and discussed. The findings are interpreted in terms of the paradigm of alternative modernities. In the direction of, but also in addition to, this paradigm, magic is introduced as a concept to denote certain highly ambiguous occurrences in the alternative modern. Magic is still very much alive and not easy to identify merely as a counterpart of rational, knowledge-generating, disembodying modernity. In this setting, spiritual healing might be seen as a form of magical self-care. Magic is neither modern nor traditional nor irrational per se, but has to be contextualized and described in terms of characteristics like holistic diagnosis, interpersonal congruence, the imaginations of agency, and efficacy.

Appropriateness of Direct Oral Anticoagulant Dosing in Patients With Atrial Fibrillation: Insights From the Veterans Health Administration

2019 ◽  
Vol 33 (5) ◽  
pp. 647-653 ◽  
Author(s):  
George C. Leef ◽  
Alexander C. Perino ◽  
Mariam Askari ◽  
Jun Fan ◽  
P. Michael Ho ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Health Care ◽  
Health Care Systems ◽  
Oral Anticoagulants ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Anticoagulation Management ◽  
Management Interventions ◽  
Care Systems

Background: Direct oral anticoagulants (DOACs) have strict dosing guidelines, but recent studies indicate that inappropriate dosing is common, particularly in chronic kidney disease (CKD), for which it has been reported to be as high as 43%. Since 2011, the Veterans Health Administration (VA) has implemented anticoagulation management programs for DOACs, generally led by pharmacists, which has previously been shown to improve medication adherence. Objective: We investigated the prevalence of overdosing and underdosing of DOACs in the VA. Methods: Using data from the TREAT-AF cohort study (The Retrospective Evaluation and Assessment of Therapies in AF), we identified VA patients with newly diagnosed atrial fibrillation (AF) and receipt of a DOAC between 2003 and 2015. We classified dosing as correct, overdosed, or underdosed based on the Food and Drug Administration–approved dosing criteria. Results: Of 230 762 patients, 5060 received dabigatran (77.3%) or rivaroxaban (22.7%) within 90 days of AF diagnosis (age 69 [10[ years; CHA2DS2-VASc 1.6 [1.4]), of which 1312 (25.9%) had CKD based on estimated glomerular filtration rate <60. Overall, 93.6% of patients, 83.2% with CKD, received appropriate DOAC dosing. Incorrect dosing increased with worsening renal function. Conclusion: Compared to recent studies of commercial payers and health-care systems, incorrect dosing of DOACs is less common across the VA. Pharmacist-led DOAC management or similar anticoagulation management interventions may reduce the risk of incorrect dosing across health-care systems.

From Self-Care to Healing Justice

2020 ◽  
pp. 141-180
Author(s):  
Patricia Zavella
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
Self Care ◽  
Historical Trauma ◽  
Communities Of Color ◽  
Spiritual Activism ◽  
Care Systems

Drawing on Gloria Anzaldúa’s thinking about spiritual activism, this chapter presents four cases of self-care as well as public practices that help communities heal from historical trauma. It argues that the work of self-care and spiritual activism in communities of color contests the individualism embedded in neoliberal health-care systems and instead crafts the collective politics of healing justice.

scholarly journals Are health care systems insensitive to needs of suicidal patients in times of conflict? The Kashmir experience

2011 ◽  
Vol 3 (1) ◽  
pp. 11-13
Author(s):  
Zaid Ahmad Wani ◽  
Arshad Hussain ◽  
Abdul Wahid Khan ◽  
M Maqbool Dar ◽  
AkashYousf Khan ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
Community Services ◽  
Suicidal Patient ◽  
Psychiatric Evaluation ◽  
Conflict Zone ◽  
Patient Reported ◽  
Important Health ◽  
Care Systems ◽  
Almost All

Suicide and attempted suicide is an important health issue and the number of people who die of suicide exceeds that of conflicts. Kashmir has been suffering from a low intensity war since last 20 years in which thousands have been killed or injured. There has been phenomenal increase in cases of psychological disorders along with suicide and and suicide attempters. Suicide in a conflict zone is viewed with indifference due to focus on the physical part of trauma. Difficulties faced by the suicidal patient and his attendants are seldom highlighted. 1408 patients who reported to emergency room for suicide attempt from 2000 to 2008 were taken for the study. All the patients underwent the hospital protocol for poisoning management. Patients were subjected to detailed psychiatric evaluation and questions were specifically asked about the difficulties encountered during management. Most of the cases were females with 92.11% belonging to the Muslim religion. 76.20% cases were from a rural background. 32.5% had been referred because of the lack of specific antidotes. Forty-three percent required arrangement of transportation by their own family members. Fifty-seven percent had been stopped for security checks along the way. Seventy-three percent felt that the attitude of the staff hostile. Twenty-three percent of patients had to share a bed. Almost all patients were questioned by security agencies within the hospital. More than 68% patient reported hostility amongst their neighbors. Suicidal poisoning is a significant health problem in Kashmir and management of these cases is fraught with difficulties across the spectrum of health care. Educating the doctors at primary care about first aid, improvement in community services followed by long term resolution of the conflict would go some way in alleviating the difficulties faced by a suicidal patient and his family in a conflict zone.

scholarly journals Pragmatic (trial) informatics: a perspective from the NIH Health Care Systems Research Collaboratory

2017 ◽  
Vol 24 (5) ◽  
pp. 996-1001 ◽  
Author(s):  
Rachel L Richesson ◽  
Beverly B Green ◽  
Reesa Laws ◽  
Jon Puro ◽  
Michael G Kahn ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Care Systems ◽  
Pragmatic Trial ◽  
Heterogeneous Systems ◽  
Full Potential ◽  
Systems Research ◽  
Pragmatic Clinical Trials ◽  
Care Systems ◽  
Electronic Health

Abstract Pragmatic clinical trials (PCTs) are research investigations embedded in health care settings designed to increase the efficiency of research and its relevance to clinical practice. The Health Care Systems Research Collaboratory, initiated by the National Institutes of Health Common Fund in 2010, is a pioneering cooperative aimed at identifying and overcoming operational challenges to pragmatic research. Drawing from our experience, we present 4 broad categories of informatics-related challenges: (1) using clinical data for research, (2) integrating data from heterogeneous systems, (3) using electronic health records to support intervention delivery or health system change, and (4) assessing and improving data capture to define study populations and outcomes. These challenges impact the validity, reliability, and integrity of PCTs. Achieving the full potential of PCTs and a learning health system will require meaningful partnerships between health system leadership and operations, and federally driven standards and policies to ensure that future electronic health record systems have the flexibility to support research.

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